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Introduction: Despite the implementation of National Rural Health Mission (NRHM), five high priority districts (HPDs) which are tribal in nature in Maharashtra show poor composite index in terms of maternal health indicators.
Objective: To find out the determinants influencing maternal health indicators among tribal population in five HPDs.
Methods: Various secondary data sources on the five HPDs in Maharashtra were reviewed.
Results: The available data suggests that five levels of determinants such as individual characteristics, family structure, community profile, cultural practises, availability, and accessibility of health infrastructure and facilities, district profile, and the governance issues, are influencing the maternal health Indicators.
Conclusion: Coordinated efforts are required for developing resources and agencies for the empowerment of this population in the long run. Tailor-made programmes to influence the health seeking behaviour of tribal mothers would play an important role and would bring about improvement in the maternal health indicators in these districts.
Ravi Duggal. Maharashtra Budget 2015-16: Continued Abject Neglect of the Social Sectors. http://righttohealthcare.blogspot.in/2015/03/maharashtra-budget-2015-16-continued.html http://www.india-seminar.com/2016/681/681_vandana_krishna.htm
http://ww.india-seminar.com/2016/681/681_vandana_krishna.htm http://www.dnaindia.com/india/report-launched-at-one-year-of-fadnavis-govtabdul-kalam-amrut-ahar-yojna-remains-largely-on-paper-2177819 PP Doke, UH Gawande, SR Deshpande. 2015. Evaluation of Janani Suraksha Yojana (JSY) in Maharashtra, India: Important Lessons for Implementation, International Journal of Tropical Disease & Health 5(2): 141-155.
Sandeep S. Nerkar, Ashok J. Tamhankar, Eva Johansson, and Cecilia Stålsby Lundborg. Impact of Integrated Watershed Management on Complex Interlinked Factors Influencing Health: Perceptions of Professional Stakeholders in a Hilly Tribal Area of India. Int J Environ Res Public Health. 2016 Mar; 13(3): 285 CJ Sonowal. 2010. Factors Affecting the Nutritional Health of Tribal Children in Maharashtra. Ethno Med 4(1): 21-36. S Jungari and B Paswan.2016. Newborn care practices among the indigenous population of Maharashtra, India: A mix method approach. Paper presented at ICRH Conference, Feb28-April2016 Niswade A et al. 2011. Neonatal morbidity and mortality in tribal and rural communities in Central India. IJCMI36(2): 150-158.
Alkire, Sabina; Meinzen-Dick, Ruth Suseela; Peterman, Amber; Quisumbing, Agnes R.; Seymour, Greg and Vaz, Ana. 2012. The Women’s Empowerment in Agriculture Index. IFPRI Discussion Paper 1240. Washington, D.C.: International Food Policy Research Institute. http://nhrc.nic.in/Documents/Publications/SMMRDC15TD_M_PART_I_CDLAI.pdf Operational holding defined as "all land which is used wholly or partly for agricultural production and is operated as one technical unit by one person alone or with others without regard to title, legal form, size or location.
Shubhangi Khapre | Mumbai | Updated: November 30, 2014 6:08 pm, The Indian Express CJ Sonowal. 2010. Factors Affecting the Nutritional Health of Tribal Children in Maharashtra. Ethno Med 4(1): 21-36. Dhaval Kulkarni | Wed, 4 Feb 2015-06:55am , dna
Rao VR. Gorakshakar AC. Sickle cell hemoglobin, beta-thalassemia and G6PD deficiency in tribes of Maharashtra, India. Gene Geogr. 1990 Dec;4(3):131-4.
The pregnant ladies with sickle cell anemia may have a lot of urinary tract infections during pregnancy. Pregnant women with sickle cell trait can also have a kind of anemia caused by not having enough iron in their blood. If you have this type of anemia, you may need to take iron supplements. In pregnancy, it is important for blood cells to be able to carry oxygen. With sickle cell anemia, the abnormal red blood cells and anemia may result in lower amounts of oxygen going to your developing baby. This can slow down the baby’s growth. What are the complications of sickle cell disease in pregnancy? Because sickling affects so many organs and body systems, you are more likely to have complications in pregnancy if you have sickle cell disease. Complications and increased risks may include: Infections. This includes infection in the urinary tract, kidneys, and lungs, Gallbladder problems, including gallstones, Heart enlargement and heart failure from anemia, Miscarriage, Death. Complications and increased risks for your developing baby may include: Severe anemia, Poor fetal growth, Preterm birth. This means before 37 weeks of pregnancy. Low birth weight, Stillbirth and newborn death.
It means the existing facilities are serving people more than their carrying capacity. The non-availability of nearby services of Sub centre, PHCs and CHCs are significantly influencing the health seeking behaviour of the population.
Except Jalgaon, all other HPDs are remaining same even after a decade.
Overall index at Dhule and Nandurbar is abysmally down. Gadchiroli shows improvement due to a number of interventions by state and NGO players.
Factors influencing maternal health indicators among tribal population in maharashtra with special focus on five high priority districts
FACTORS INFLUENCING MATERNAL
HEALTH INDICATORS AMONG TRIBAL
POPULATION IN MAHARASHTRA WITH
SPECIAL FOCUS ON FIVE HIGH
Ajeesh Sebastian & Shahina Begum
Dept. of Biostatistics
National Institute for Research in Reproductive Health (ICMR),
Health - a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity. (WHO. 1948)
Main determinants of health include
The social and economic environment,
the physical environment, and,
The person's individual characteristics and behaviors.
The inequities in how society is organized mean that the freedom to lead a
flourishing life and to enjoy good health is unequally distributed between and
within societies. (WHO commission on social Determinants of Health, 2008)
Conceptual Framework – WHO 2008
Much of the tribal budget goes towards infrastructure development, but there is
barely enough budget for the maintenance of those assets, or for human
development. (Krishna, S. 2016)
Poor planning and implementation Eg: The Dr APJ Abdul Kalam Amrut Ahar
Yojna. (DNA report,2016)
Poor utilization by the target population. Eg: JSY evaluation(PP Doke, UH
Gawande, SR Deshpande. 2015)
SCHEMES FOR SCHEDULED TRIBE
Early age marriages. (SS Nerkar et al. 2016)
Dependency of tribal people upon spiritual security they receive from their
Practises for normal delivery by making changes in food consumption
(CJ Sonowal. 2010, Jungari and B Paswan.2016, Dilnaz Boga. 2015)
Child feeding practises. (Neonatal Disease Surveillance Study - 2006-07)
Spacing between deliveries. (Niswade A et al. 2011)
All the household level hard work continues even during pregnancy. (SS
Nerkar et al. 2016)
Poor spending on health.
Trend towards self-treating themselves through herbal medicines or allopathic
medicines bought from a pharmacy also reported.
Embarrassment to discuss reproductive problems
(A Shukla. 2012).
HEALTH SEEKING BEHAVIOUR
PROFILE OF 5 HPD DISTRICTS
Dhule, Gadchiroli, Jalgaon,
Nanded, and Nadurbar
Issues related with equitable health
care and poor performance in health
outcomes. (PIB. 2015)
listed in the Backward Regions
Grant Fund Programme under
Ministry of Panchayati Raj
These districts are characterized by
agrarian economy and majority of its
population lives in rural areas.
(Census. 2011; NRHM PIPs. 2008-
The Major ST groups in the 5 HPDs (Census 2011)
District Major tribal groups in rural area (>1000 population)
Nandurbar Bhil, Kokna, Gamit, Koli Mahadev, Dhanka, Koli Dhor
Dhule Bhil, Kokna, Koli Dhor, Gamit, Pardhi, Koli Mahadev, Thakur
Jalgaon Bhil, Koli Dhor, Koli Mahadev, Pardhi, Dhanka, Thakur, Naikda,
Koli Malhar, Korku
Gadchiroli Gond, Pardhan, Halba, Kawar, Oraon
Nanded Andh, Koli Mahadev, Kolam, Gond, Bhil, Pardhan, Naikda,
Growth rate of tribal population in five HPD districts
between 2001 and 2011
Dhule -4.59%, Gadchiroli - 1.17%, Jalgaon - 3.86%, Nanded - 1.1%, Nandurbar -
THE SOCIO ECONOMIC PROFILE OF THE THE TRIBAL
POPULATION – SECC 2011
GENDER (CENSUS 2011 & SECC 2011)
Gender specific indicators Maha
Women owning a house and/or
land (alone or jointly with others)
Women having a bank or savings
account that they themselves use
The tribal land holdings are characterized
by men ownership. The share of women
who hold land is critically low. (Alkira S.
et al. 2012)
Education status of Women (7-80+) in five HPDs
Chief Minister of Maharashtra: Lack of nourishment coupled
with sustained earning that often lead to migration was a cause of serious
concern in tribal areas of Maharashtra. (Khapre. 2014)
Migration to other parts of the state as well as to neighbouring states in
search of seasonal jobs under contractors. (CJ Sonowal. 2010)
Tough to track pregnant women. (D Kulkarni. 2015)
FOOD AND FOOD SECURITY
A report of enquiry based on the Starvation, Malnutrition and Malnutrition
Related Deaths of Children in 15 Tribal Districts of Maharashtra points out:
Unstable cereal production
20 to 50 percent landless labour households who consume less than 2300
calorie value of food
Production of jawar & bajra is coming down and is substituted by the
production of cash crops.
huge deficit between the recommended norm and what is available for
consumption in respect of cereals, sugar, pulses, vegetables, fruits, oil/fat,
milk, meat and fish.
The existing PDS does not distribute coarse cereals such as jawar, bajra and
ragi for which members of tribal households have a preference.
PDS caters to only 50 percent of the requirements of a family .
The prevalence of sickle cell hemoglobin (HbS), beta-thalassemia trait and G6PD
among some important Gond related endogamous tribes in Maharashtra, India.
The HbS gene frequency varies from 0.0530 to 0.1805, the beta-thal gene from 0
to 0.0283 and Gd- gene from 0.0189 to 0.1120. (Rao VR and Gorakshakar AC.
Glucose-6-phosphate-dehydrogenase (G6PD) deficiency was observed in the
Gamits (31.4%), and Bhils (16.3%) in Maharashtra. Deficiency of this enzyme is
highly polymorphic in those areas where malaria is/has been endemic.
(Mukherjee MB et al. 2015)
Sr. No Tribal Group District Sickle Cell Carriers (%)
1 Otkar Gadchiroli 35
2 Pardhan Nanded 33.7
3 Pawara Dhule, Jalgaon 25.18
4 Madia, Gond Gadchiroli 20.8
5 Bhil Nandurbar 20.6
6 Halbi Gadchiroli 13.93
8 Rajgond Gadchiroli 10.88
10 Tandvi Jalgaon 8.33
14 Kokana Dhule 3.50
15 Andha Nanded 1.97
% of sickle cell carriers in different tribal groups in five HPD
AVAILABILITY OF HEALTH FACILITIES
*Tiers of Health Care Infrastructure and the Applicable Population Norms
Area (as per norms)
Situation in Tribal Areas
of Maharashtra including
5 HPDs (in reality)
Sub-Centre 3000 4378.258
Primary Health Centre 20000 28590.72
*Ministry of Tribal Affairs, Statistical Profile of Scheduled Tribes in India 2013
Number of Sub Centres, PHCs & CHCs in Tribal Areas
(as on 31st March 2015)
Sub Centres PHCs CHCs
Required Shortfall Required Shortfall Required Shortfall
Maharashtra 9006077 3002 945 450 135 112 45
Building Position for Sub Centres, PHCs, and CHCs in Tribal Areas (as on 31st March 2015)Maharashtra
Total Number of
required to be
2057 220 315 26 67 7
Human Resource Required In position Shortfall
Health Worker [F] / ANM at Sub Centre & PHC 2372 6833 0
Health Worker [M] at Sub Centre 2057 1375 682
Health Assistants [Male] at PHCs 315 700 0
Health Assistants [Female] / LHV at PHCs 315 739 0
Total Specialist at Community Health Centres 268 83 185
Obstetricians & Gynaecologists at CHC 67 29 38
Surgeon at CHCs 67 16 51
Physicians at CHCs 67 15 52
Nursing Staff at PHCs & CHCs 784 646 138
Lab Technicians at PHCs & CHCs 382 400 0
CONCLUSION AND RECOMMENDATIONS
Necessity of tailored programmes with a focus on the social determinants of
health influencing the maternal health indicators.
Need to encourage context-specific and culturally and socially acceptable
provisioning of care.
Addressing the social determinants of health through health system
strengthening and inter-sectoral convergence.
Improved community participation.